Heart Failure Flashcards
Define heart failure
The inability of the heart to pump adequate amounts of blood to meet the metabolic demands of the body
Give 6 factors that can potentially decrease BNP levels seen clinically
- Obesity
- Diuretics
- ACE inhibitors
- Beta blockers
- Angiotensin 2 receptor blockers
- Aldosterone antagonists
Recall the components of the first line treatment of chronic heart failure (ABAL)
- A - ACE inhibitor
- B - Beta blocker
- A - Aldosterone antagonist
- L - Loop diuretic
What are the 4 main potential causes of chronic heart failure?
- Ischaemic heart disease
- Valvular heart disease
- Hypertension
- Arrhythmias
What is the most common valvular heart disorder that can cause chronic heart failure?
Aortic stenosis
What is the most common arrhythmia leading to chronic heart failure?
Atrial fibrillation
What are the 5 key features of a patient presenting with chronic heart failure?
- Dyspnoea
- Cough
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Peripheral oedema
In what subgroup of patients with chronic heart failure should ACE inhibitors be avoided in without specialist supervision?
Those with valvular heart disease
When would an aldosterone antagonist be indicated in the treatment/ management of chronic heart failure?
When there is a reduced ejection fraction and symptoms are not controlled by a ACE inhibitor and beta blocker.
Briefly outline the 3 factors which are thought to contribute to the precipitation of PND at night
- Fluid shift when the patient lies flat i.e. covering a larger surface area of the lungs
- Less reactive respiratory centre during sleep
- Less circulating adrenalin during sleep
Suggest the 4 main causes of de novo acute heart failure
- Ischaemia
- Viral myopathy
- Toxins
- Valve dysfunction
What are the 4 main symptoms associated with acute heart failure?
- Breathlessness
- Reduced exercise tolerance
- Oedema
- Fatigue
What are the 6 main clinical signs associated with acute heart failure?
- Cyanosis
- Tachycardia
- Elevated JVP
- Displaced apex beat
- Bibasal crackles (may also have a wheeze)
- S3 heart sound
What are the 4 main components of the diagnostic work up for patients with acute heart failure?
- Bloods - checking for anemia, electrolyte abnormalities and infection
- CXR
- Echo
- BNP
Suggest 3 potential finding on CXR for patient with acute heart failure
- Pulmonary venous congestion
- Interstitial oedema
- Cardiomegaly
What 2 conditions can potential be identified on echo in patient with acute heart failure?
- Pericardial effusion
2. Cardiac tamponade
Define cardiomegaly
A cardiothoracic ratio greater than 50%
Recall the 5 main features of heart failure that can be seen on CXR
- Pulmonary oedema/ congestion
- Septal/ Kerley B lines
- Cardiomegaly
- Upper lobe vessel enlargement
- Pleural effusion
What are the 3 factors that determine how fluid moves between the capillaries and the interstitium?
- Hydrostatic pressure
- Oncotic pressure
- Capillary permeability
What is the most common cariogenic cause of pulmonary oedema?
Left sided heart failure
Suggest 4 non cariogenic causes of pulmonary oedema
- Pulmonary infections
- Inhalation of toxic substances
- Trauma to the chest
- Sepsis
Give 2 medical conditions that lead to a low oncotic pressure, which may in turn lead to pulmonary oedema
- Liver Failure
2. Nephrotic syndrome
What are the most common valve dysfunctions caused secondary to heart failure?
Functional mitral and tricuspid regurgitations
Suggest 3 potential causes of diastolic heart failure
- Pericardial disease
- Restrictive cardiomyopathy
- Tamponade
Recall the Major Framingham diagnostic criteria for congestive heart failure (SAW PANIC)
S - S3 heart sound (gallop)
A - Acute pulmonary oedema
W - Weight loss of more than 4.5 kg in 5 days once treated
P - Paroxysmal nocturnal dysponea A - Abdominojugular reflux N - Neck Veins distended (raised JVP) I - Increased cardiac shadow on CXR (cardiomegaly) C - Crackles in lungs
Recall the Minor Framingham diagnostic criteria for congestive heart failure (HEART ViNo)
H - Hepatomegaly E - Effusion, pleural A - Ankle oedema bilaterally R - exeRtional dyspnoea T - Tachycardia
Vi -Vital capacity decreased by a third of maximal volume
No - Nocturnal cough
Define the 4 grades of the NYHA Classification of heart failure
Grade 1 - No limitation of function
Grade 2 - Slight limitation of function. Moderate exertion causes symptoms but no symptoms at rest.
Grade 3 - Marked limitation. Mild exertion causes symptoms but no symptoms at rest
Grade 4 - Severe limitation. Any exertion causes symptoms. May also have symptoms at rest (but not always).
Give 4 contraindications for the use of beta blockers in the treatment of heart failure
- Asthma
- 2nd or 3rd degree heart block
- Sick sinus syndrome
- Sinus bradycardia (<50 bpm)
Name the calcium channel blocker that is recommend for use in the management of heart failure
Amlodipine